改良中间入路与传统中间入路在腹腔镜右半结肠切除术中的比较研究  

Comparison of cranial-to-caudal medial versus traditional medial approach in laparoscopic right hemicolectomy：a case-control study

作　　者：郑波波[1] 王楠[1] 吴涛[1] 乔庆[1] 周帅[1] 张波[1] 杨莹[1] 谢爽[1] 王珂[1] 何显力[1] 

机构地区：[1]第四军医大学附属唐都医院普通外科,西安710038

出　　处：《中华胃肠外科杂志》2015年第8期812-816,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国际科技合作与交流项目（2013DFA32110）

摘　　要：目的：对比改良中间入路与传统中间入路在腹腔镜根治性右半结肠切除术的近期疗效。方法收集第四军医大学附属唐都医院普通外科2013年6月至2014年8月期间实施改良中间入路腹腔镜根治性右半结肠切除术（采用从胰头前区域为中心的“耳型”改良中间入路，改良入路组）的52例结肠癌患者临床资料，并与同期实施的传统中间入路腹腔镜根治性右半结肠切除术（传统入路组）的47例结肠癌患者的临床资料进行比较。结果两组患者年龄、性别、体质量指数、肿瘤位置、手术类型等一般资料比较，差异无统计学意义（P＞0．05）。与传统入路组相比，改良入路组术中出血量明显减少[（38．4±12．4） ml比（87．2±24．6） ml， P＜0．05]，手术时间显著缩短[（105．6±38．8） min比（138．2±39．5） min， P＜0．05]，术中血管损伤率降低[5．8％（3／52）比25．5％（12／47），P＜0．05]；两组在手术标本质量评价、淋巴结清扫数量、中转开腹率、吻合口并发症、术后肠梗阻及切口、肺、泌尿系感染等并发症发生率、术后住院时间比较，差异无统计学意义（P＞0．05）。结论在腹腔镜根治性或扩大根治性右半结肠切除术中采用改良中间入路，可显著减少术中出血量，缩短手术时间。Objective To compare the short-term efficacy of modified medial （M-M） with traditional medial（T-M） approach in laparoscopic right hemicolectomy（LRHC）/or extended laparoscopic right hemicolectomy （ELRHC） for right or hepatic flexure colon cancer. Methods A comparative, retrospective study was performed that included all the patients scheduled for LRHC or ELRHC for right or hepatic flexure colon cancer between June 2013 and August 2014. The following factors of two groups were assessed： patient characteristics, operative details, pathology, and surgical outcomes. Results A total of 99 patients were evaluated, including 52 patients in the M-M group and 47 patients in the T-M group. Age, gender, body mass index, American Society of Anesthesiology （ASA） class, tumor location, diameter of tumor were not significantly different between the two groups. As compared to the T-M group, M-M group was associated with a significantly shorter operative time [（105.6±38.8） min vs. （138.2±39.5） min, P〈0.05], less estimated mean blood loss[（38.4±12.4） ml vs. （87.2±24.6） ml, P〈0.05] and lower intraoperative vascular damage rate [5.8%（3/52） vs. 25.5%（12/47）, P〈0.05]. There were no significant differences between these two groups in terms of intraoperative complications , CME, conversion rate, number of harvested lymph node, postoperative ileus, hospital stay, wound, lung and urinary system infections. Conclusion The use of M-M approach in laparoscopic right hemicolectomy provides short-term benefits in operative time and estimated blood loss compared with traditional medial approach.

关 键 词：结肠肿瘤 腹腔镜右半结肠切除术 改良中间入路 

分 类 号：R735.35[医药卫生—肿瘤]